tango

Providing personal care, cleaning, and childcare services in a home setting. | No nursing or healthcare-specific experience or licensure, and skills do not match the healthcare-focused role. | tango is a leader in the home health management industry and is preparing for significant growth! Our mission is to deliver innovative, home-based, post-acute solutions through proprietary technology and proven processes. We partner with health plans to provide a comprehensive suite of products and services designed to manage the total cost of care. We are currently looking for a Utilization Review Nurse to join our growing team! POSITION DESCRIPTION: The Utilization Review Nurse acts as a liaison in the coordination of resources and services to meet patients’ needs, promotes teamwork to optimize efficient and cost-effective use of health care resources, monitors the health care delivery plan to maximize positive patient outcomes, and maintains compliance with applicable laws and regulations and the policies of Professional Health Care Network. The clinician will monitor adherence to ensure the effective and efficient use of home care-based services and monitor the appropriateness of homecare admissions, resumptions of care, reauthorizations, and extended cert periods. Primary duties include, but are not limited to: ESSENTIAL FUNCTIONS: • Processes patient prior and reauthorization requests as outlined by company policy. • Makes determination of the need for continued home health care services by reviewing documentation submitted by providers in accordance with Medicare guidelines. • Refers to the Utilization Review Physician Advisor cases that do not meet established guidelines for admission or continued care. • Maintains accurate records of authorizations and communication with providers and payer plans pertaining to authorization for all patients. • Assists provider staff and team members in identifying patient needs and coordinating care. • Assists provider staff and team members in efficient and cost-effective utilization of health care resources and monitors patient progress and outcomes. • Facilitates communication and provides ongoing customer service support to payer plan case managers, patients and provider staff and team members. • Prepares and submits any required status or summary reports in a timely manner. • Periodic weekend and holiday rotation and availability to address after hour health plan member needs related to home health management. • Reviews documentation and provides feedback to clinicians regarding CMS Chapter 7 and Milliman Care Guidelines to ensure accurate assessment and review data, medical records reflect compliance with medical necessity, homebound status, visit utilization supported by individual patient assessment/ documentation support and transition (discharge) planning. • Identifies problems related to the quality of patient care and refers them to the Quality Assurance Committee/QPUC. • Assists the Utilization Review Committee/QPUC in the assessment and resolution of utilization review problems. • Other duties as required and/or assigned. OFFICE LOCATION: • Remote QUALIFICATIONS • Is a graduate of an accredited school of professional nursing or an accredited practical or vocational nursing program. • Has at least two years of general nursing experience in medical, surgical, or critical care, and at least one year of utilization review/management, case management or recent field experience in home health. • Is currently licensed as a registered nurse, practical nurse, or vocational nurse in good standing through the Arizona Board of Nursing and other State Boards of Nursing as applicable. • Is detail oriented and displays good organizational skills as well as good oral and written communication skills. • Excellent time management skills with a proven ability to meet deadlines. • Is self-directed, flexible, cooperative, and exhibits the ability to work with minimal supervision. • Working knowledge of home care regulatory and federal requirements. KNOWLEDGE AND EXPERIENCE: • Requires knowledge in the areas of home health community-based services; utilization/case management experience is preferred. • Must have a working knowledge of homecare, managed care, medical/nursing staff procedures, and community resources. NCQA and URAC knowledge is helpful. • Computer skills such as MS Office products - Outlook, Excel, Word, Adobe, and the ability to work within multiple electronic medical management systems. CONTINUING EDUCATION REQUIREMENTS: Company personnel are expected to participate in appropriate continuing education as may be requested and/or required by their immediate supervisor. In addition, company personnel are expected to accept personal responsibility for other educational activities to enhance job related skills and abilities. All company personnel must attend mandatory educational programs. tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.

Lead a team managing provider relations and value-based care performance to improve quality and cost-effectiveness in home health services. | Bachelor's degree, 5-7 years in provider relations or value-based care, 2+ years leadership, strong healthcare knowledge, and project management skills. | Brief Description • Position is remote, however you must live in MST of PST time zone to be considered for this opportunity** Position Summary tango is a delegated entity that partners with health plans to manage the full spectrum of home health services for their members. We are seeking a Manager of Provider Relations and Value Based Performance to lead a team dedicated to strengthening provider partnerships and improving performance within value based arrangements. This leadership role plays a critical part in ensuring that our network of home health providers delivers high-quality, cost-effective care. Key Responsibilities Leadership & Team Management: • Lead, coach, and mentor a team of provider relations specialists. • Set team goals and performance standards in alignment with tango’s strategic objectives and health plan expectations. • Foster a culture of accountability, collaboration, and provider-centric service. Provider Relations & Network Engagement • Serve as the primary escalation point for provider concerns, performance issues, and network questions. • Build and maintain strong, trust-based relationships with home health agencies and partner providers. • Communicate program updates, expectations, and performance metrics to ensure network alignment. Value-Based Care Performance Oversight • Monitor provider performance under delegated value based care arrangements, focusing on quality, utilization, and patient outcomes. • Collaborate with internal analytics, clinical, and operations teams to identify trends, gaps, and opportunities for improvement. • Drive provider engagement in performance improvement initiatives to meet shared savings and quality targets. Strategic & Operational Support • Translate tango strategy into operational tactics to support provider engagement and performance. • Assist in optimizing tango’s value-based care frameworks and incentive models by providing insights from the field. Qualifications Education & Experience: • Bachelor’s degree in healthcare administration, business, public health, or a related field required. • 5–7 years of progressive experience in provider relations, network management, and value-based care, preferably in a delegated or managed care environment. • 2+ years of direct people leadership experience. Knowledge, Skills, & Abilities • Strong understanding of delegated health plan-provider relationships and value based care models, especially in home health or post-acute care. • Proven ability to interpret performance data and lead successful provider performance initiatives. • Exceptional interpersonal, communication, and negotiation skills. • Strong project management skills with the ability to manage multiple priorities in a fast-paced, evolving environment. Work Environment • Remote, with periodic travel to provider sites and internal meetings as needed. • Must be comfortable working across multiple health plan partners and adapting to varying delegation requirements. tango provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws. tango will make reasonable accommodations for qualified individuals with known disabilities unless doing so would result in an undue hardship.